Nutrition Therapy Recommendations for Diabetes | Feature

The American Diabetes Association recently released nutrition therapy recommendations for the management of diabetes. Published in Diabetes Care, the new statement provides a set of recommendations based on reviews of recent clinical investigations (Table 1). The statement calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriately portioned sizes as part of an eating plan. These plans must take into account individual preferences, culture, religious beliefs, traditions, and metabolic goals.

Nutrition Therapy Is Effective

The American Diabetes Association recognizes that nutrition therapy is provided by a variety of health professionals, and published research shows that it is effective when delivered by various health professionals. Studies suggest that nutrition therapy produces A1C reductions similar or greater than what is expected with treatment with currently available pharmacologic treatments for diabetes.

“Ideally, patients with diabetes should be referred to registered dietitians (RDs) for diabetes nutrition therapy or participate in diabetes self-management education (DSME) programs that include instruction on nutrition soon after their diagnosis,” says Alison Evert, MS, RD, CDE, who was part of the writing group that developed the position statement. The position statement from the American Diabetes Association highlights guidelines from the Academy of Nutrition and Dietetics that recommend several effective structural components when implementing medical nutrition therapy for adults with diabetes (Table 2). “An important goal of nutrition therapy includes collaborating with healthcare providers to develop individualized eating plans and to encourage people with diabetes to get the ongoing support they need to promote health behavior changes.”

Individualizing Approaches

The American Diabetes Association recommends that all people with diabetes make nutrition therapy a part of their diabetes treatment plan. “No standard meal plan or eating pattern will work universally,” says Evert. Use of the term “diet” is also discouraged, with the focus shifting toward use of “eating patterns” or “eating plan” and an emphasis on healthful food choices. The recommendations also include a new section on eating patterns because many people with diabetes do not focus on single nutrients, such as carbohydrates, protein, and fat. The statement notes that health literacy and numeracy, access to healthful choices, and readiness, willingness, and ability to change behaviors are other important
factors to consider.

Highlighting Key Recommendations

There is no conclusive evidence to suggest an ideal amount of carbohydrate intake. However, the carbohydrates that are eaten should come from minimally processed, nutrient-dense foods, such as vegetables, whole grains, fruits, legumes, and low-fat dairy products rather than from sources containing added fats, sugar, or sodium. Similarly, evidence remains inconclusive about the ideal amount of total fat intake. In type 2 diabetes, a Mediterranean-style, monounsaturated fatty acid-rich eating pattern may benefit glycemic control and cardiovascular disease risk factors. For these patients, it is recommended as an effective alternative to lower-fat, higher-carbohydrate eating patterns. Patients working to manage their weight should still eat good fats in moderation.

A key recommendation, according to Evert, is that people with diabetes should limit or avoid intake of sugar-sweetened beverages to reduce their risk for weight gain and worsening of their cardiovascular risk profile. “Reducing sodium intake to less than 2,300 mg per day is also encouraged for people with diabetes,” adds Evert, “and there may be additional sodium reductions for those with hypertension.” She notes that studies indicate that most Americans eat far more sodium than they should.

“Eating plans need to fit patients’ food preferences and lifestyle so that it can be consistently followed for the long haul.”

The position statement reports that people with diabetes do not appear to benefit from using omega-3 supplements for preventing or treating heart disease. Patients with diabetes should eat fatty fish at least two times per week. In addition, there is no clear evidence of benefit from vitamin or mineral supplements for those with diabetes who do not have underlying vitamin or mineral deficiencies. There also is no evidence supporting the use of cinnamon or other herbs or supplements for the treatment of diabetes.

A Concerted Effort

Evert says that scientific evidence is still limited on various eating patterns and their impact on health outcomes in people with diabetes. The key for healthcare providers is to encourage participation in DSME programs and collaboration with RDs, she says. “We need to promote the importance of nutrition therapy in the overall treatment of diabetes. Eating plans need to fit patients’ food preferences and lifestyle so that it can be consistently followed for the long haul.”

In addition, healthcare providers should offer patients practical tools for day-to-day food plans and behavior changes that can be maintained over the long term. Evert adds that clinicians should strive to help patients choose appropriate eating plans that consider individual metabolic goals, such as glucose and lipid levels. “There is no singular ‘quick fix’ to ensuring that patients get the nutrition they need for good health.”

Inzucchi SE, Bergenstal RM, Buse JB, et al;American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364-1379.